How is this nocturnist offer I got?
Top 5 US metro area, 1000 bed hospital/Level 1 center
7on/7off schedule, 182 shifts/year 11pm-8am
2 Docs per night
8-9 admits per night per doc (expected to to 1 H&P/hr), no trauma or OBGYN admits.
closed ICU, ICU doc does ICU admits
No procedures, No codes
Cross-cover done by 2 APRNs
some nights there will be a 3rd APRN to help with admits that you will co-sign and those count towards your 8-9/night.
Comp: 315K flat. No RVU or other bonus. Can pick up extra night shifts or swing shifts for $1500/shift. Can come early to shift and do extra admits for 150/admit before your shift starts.
20K sign bonus
$192/hr without cross coverage or icu/procedures is seemingly a great base until you realize they're cramming 12-14 hours worth of work into 9 hours.
1 admit per hour is objectively ALOT- The gold standard is 90 minutes per admission. And that's without having other responsibilities.
Who is handling rapid responses? If those don't count towards your cap or productivity, you could have some very difficult nights.
9 chest pain rule outs, kindey stones, or diverticulitis? All day every day. But it doesn't take more than a couple super sick chronically ill train recs with impossible med recs or family situations to suck your soul and time. I do 6-8 admits per 12 hour shift and I find that's the real sweet spot to avoid burnout. Every night I do 9-10 I really feel exhausted the next couple days.
I'm honestly not sure I could do have been a nocturnist this long if I had to be doing 9 admits each and every night for 7 on/7 off.
Big question to ask here, are there med rec techs at night? Give me perfectly reconciled med recs and I can bang out admits in 30-45 minutes easy. If I'm having to call facilities or pharmacies, forget about it.
Also ask other docs, are they actually going home on time at 8am or they staying up to finish their notes? A 10 hour night drops your rate to $173, a 12 hour night takes it down to $144...which without a bonus, are really no longer attractive rates.
Other issue is the no productivity bonus. If you're billing 3.5 wRVUs for 9 admissions over 182 shifts it's 5700 rvus a year. That's 90th+ percentile for a hospitalist's productivity.
My productivity bonus structure would pay me around 100k a year bonus for that kind of productivity.
Overall, could be a good gig for someone young and efficient, or could be a real wolf in sheep's clothing.